It’s now been about one year since much of the world went into lockdown, and even as different areas have already re-opened to some extent, it’s fair to say that for most of us life has been very unusual. For people with diabetes, a disease intensely affected by lifestyle decisions, the changes triggered by the pandemic have loomed especially large.
It was anybody’s guess as to how the strange year would affect glycemic management in patients with Type 1 diabetes. On the one hand, the pandemic brought with it economic devastation, stress and anxiety, the closure of gyms and exercise centers, and a boom in comfort food and emotional eating. On the other, with so much time spent at home, it has perhaps brought a new opportunity for people with diabetes to pay attention to the management of their condition and establish healthy routines.
A new study of British children with Type 1 diabetes has indicated that overall, the effect has been positive. Looking at the months before and after lockdown began in late March 2020, researchers found that HbA1c improved and blood sugars were more often in range.
The lead author of the study, Dr. Neil Lawrence of Sheffield Children’s Hospital NHS Foundation Trust, stated that “children and families found it easier to manage this disease when they were forced to stay at home.” The results haven’t been published yet, but were presented at the annual conference of the Endocrine Society, held online this year.
In fact, there have been a great number of studies on the issue. Although the results are not in any way unanimous, many have found that glycemic control improved during the pandemic year. In Italy, children and adults with T1D (but not teenagers) enjoyed improved blood sugar. Two studies from Spain found big improvements across the board for patients, with one researcher suggesting that “these results suggest that having more time for self-management may help improve glycemic control in the short term.” Multiple other studies found no significant differences before or after the pandemic took hold. Of course, there’s no reason to suspect that different people in different areas experiencing different lockdowns would all have the same results.
At least one study we’re aware of was especially sensitive to the fact that the pandemic’s effect on diabetes outcomes might differ from one population to another. A Scottish study published over the summer found modest glycemic improvements overall among patients with T1D; unfortunately, when the patients were sorted for socioeconomic status, researchers found that the results different significantly for the haves and have-nots. “Higher levels of socio?economic deprivation were a strong, independent predictor of deteriorating glycaemic control during lockdown.”
There has always been a big socioeconomic gap in diabetes outcomes. Even in countries with robust socialized health care systems, wealthier patients generally have better blood glucose numbers. The difference is even bigger in countries with significant wealth disparities. It’s sad but unsurprising that the pandemic would have exacerbated this gap, perhaps by sorting the diabetes world into those that could work from home and easily afford all their medication and equipment from those that could only barely get by. “Deprivation may be disproportionately associated with poorer diet and reduced exercise during lockdown, as well as increased stress from childcare commitments and uncertainty around employment and income.” The study is ultimately just one small piece contributing to the broad picture we have that the most deprived members of our society have been disproportionately victimized by the pandemic—both by the virus itself and the economic devastation it has wrought.
For a more stark example of this unfortunate gap, consider this very small study from India, which found that patients with Type 1 diabetes experienced a disastrous decline in glycemic control. Mean A1c worsened from 8.8% to 10.0%, the latter indicating a frighteningly high average of 270 md/dL. Why did things get so bad? The authors proposed that those numbers skyrocketed “mainly due to non availability of insulin/glucostrips during lockdown period.” It’s one thing to face factors like stress and lack of exercise, quite another to deal with the basic unavailability of the tools you need to stay alive. It’s scary, and it isn’t just a problem in emerging economies such as India’s—in the United States, high insulin prices have forced many to ration their life-saving medicine, a problem that has definitely not gotten better during the economic downturn.
Back in Great Britain, Dr. Lawrence suggested that the good news from his study of T1D kids can help highlight the issues that patients face day-to-day. “This helps us to understand the pressure that is put on patients and families when trying to live normal busy lives with activities outside of the home.”
We can be hopeful that the pandemic has taught us the value in the elements of better diabetes control: eating carefully and consistently, checking blood sugar often, avoiding peer pressure. But we also shouldn’t lose sight of how desperately some people with diabetes struggle to get by, and how much more difficult the global economic decline has made their lives